The URL can be used to link to this page

Home My WebLink About15968 (9) '�`\ 1� CITY OF DIAMOND BAR �r- � DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES f � 21660 E.Copley Drive Suite 190 (909)860.3195 Fax(909)861-3117 �"� PR ES$ ��'��, BUILDING PERMIT APPLICATION FIRMLY � JOBSITE r -��/�� # APPLICATION PERMIT ��' c' p/� o ADDRESS �C..��GG��TE�At'��Nr�P�D �Z�' DATE �� NUMBER I �� I'; � � ISSUE 1 � � TYPE OCC APN LOT TRACT � DATE � CONST. GROUP p OWNER T'2�t�-11a1E I,GC�c�"Ca� GG o ADDRESS �� '(pC7C3 ZONING SETBACKS FRONT � CITY � � ZI�ZbJ4 TE . �� 7- G�" REAR RW C'— APPLICANT_� TEL. C dz t SIDE/SIDE STREET Ryy r- � CONTRACTORL'I��--TE-�'- ��-T�'� �� SIDE �-_ Q ADDRESS11c3��U+L1�lTl-'IZ � CITY�)(ZN u'�'� ZIP�17-�i��, TELL°�C�3FCi�''�4Z PROPOSED USE w ARCH/ENG/ z DESIGNER��I�AG� � ADDRESS�'�?yZ_ �LI f�2T"Hi!� 1�(� NO.D1MEL. Np. NQ � C�TY I_-�l P� L� ZIP�� TEL� UNITS STORIES BEDROOMS � — DESCRIPTION S�.FT. FACTOR PSF ADJ.AREANALUATION � OWNER-BUIL�ER DECLAFATION SFR/ADD/REM O p I HEREBY AFFIRM UNDER PB�IKTY OF PERNqY TMAT I AM EXEMPT FROM THE CONTRACTOHS LI� Gflfe9B/CdfpOR W CENSEUWFORTMEFOLU7YYINGREASON(SEC.7031.58USWESSANDPROFESSIONSCODE:ANVCITYOF (f� CJ COUNTYWFIICHREOUIRESAPERMR7000NSTRUC7,AL7ER.IMPROVE.DEMOLISH.ORREPAIRnNvsiRUC- W Patio/Deck �� TURE,PHIOR TO Ii$ISSW WCE.AL50 RE�UIRES THE APPLICANT fOR SUCM PERMIT TO FILE A SIGNE� W STATEMENT THAT HE Ofl SHE IS LICENSED PURSUANT 70 THE PROVISIONS OF THF CONTRACTOqS LI- � CENSE lAW(CHAPTER 9((S7MMENCINO WITH SECTION]000�OF DIVISION 3 OF THE BVSMESS AN�PRO- LL POOUSP3 FESSpNS ODDE)OR THATHE OR SHE IS E%EMPT THEREFROM MIO THE BASIS FORTHE ALLEGED EXEMP- (� TqN.ANVVIOLATI0NOF5LCTION7o31.5BVAHVAPPI.ICANTFORAPEflMITSU&IECTSTMEAPPLIGANTTO Z Re-Raof � �qVil 7ENALTV OF N07 MORE TIMN FIVE HUNDRED DOLURS(j500).): � OI,ASOWNEROFTHCPROPERTY,OFMVEMPLOYEESWITHWAGESASTHEIRSOIECOM7EN5ATION, COmRlefCial YV0.L DO TME WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC.70dd,BUSI- Q N NESS IWO PROGESSIONS I�E:THE CANTRACTORS LICENSE UW DOES NOT APPLY TO AN OWNER OF � PROPERTY VhlO BUILDS OH IMPROVES TIEREON,AND WHO DOES SUCM WORK HIMSELF OR HEHSELF OR � TMROUGHHISORHEPOWINEMPIOYEES.PROVIOEDTHATSUCHIMPROVEMEN75ARENOTINTENDEDOR m Q OFFEREDFORSALEIF.HOIYEVERTME9llIL�INGORIMPiiDVEAIENTIS50lDWITHINONEYEAROFCAMPIE- Z TbN,THE OWNER-6UILDER WILL HAVE THE BUPOEN OF PROVING 7H�7 HE OR SHE DID NOT BUILD OR � IMPROVE FORTHE PURPpSE OF SALE�. W ❑I,ASOWNEROFTHEPROPEflTV,AME%CLUSNE�_YCANTRACTINGWITNLIGENSEDWNTRACTORS � TO CONSTRUCf THE PRQIECT(SEC.]04l,BUSINESS AND PROFESSIONS CODE:THE GONTRAGTOHS LI� V8It18�lOf1 qp,J,qqEq W CENSEIAWDOE3NOTAPPLYTOANOWNEROF/1PROPEHTYWHOBUI�GSORIMPROYESTHERF:ON,AND �-- � 'MIOCONTMCTSFORSUGMPftQlECTSWITHACON1RqClOR(5)LICENSEDPURSUANTTOTHECXJNTMG QUANTITY DESCRIPTION FEE Y TORS LICENSE UW.). i O ❑IAMEXEMPTUNDERSEC.__ __. _B.aPC.Foq7HISREA50N Q � ' V � V � DATE '_... _ � .� . .. .,_�_- — OWNER F- � LICENSED CONTRACTORS DECLARATION W � �' ��t p�� C �)N�L� I T 1 � rc�.N _ I MEREBY AFFIRM UNUER PENALTY OF PERIUFY THAT IAM IICENSED UNDEfl PROVISIONS OF CHAPTER U. � Y(COMMENCINO WI7H SECTION 7a00)OF CIVISION J OF THE BUSINESS ANO PROFESSIONS COOE.AND Z �� YY LICENSE IS IN FULL FORCE ANp EFFECT. m � LICENSE CLASS��__ LIC.NO. L^ 1 YK.�� J _ � wDATE_�C{,_��1 conrancroa��Li.TFR l a..�t�'1iC a � WOPKERS'COMPENSATION DECLARATION Q � I HEREBY AFFIRM UNDER PENALTV OF PERIURV ONE CF TNE FOLLOWING UE^URATIONS: U � Z p 1 HAVEAND WILL MAINTAiN A CER7IFICATE OF CONSENT TO SELF-INSUR[FOR WORKE{i5' a � = 7�'., GOMPENSATION,AS PROV!DED BY SEGTION 9]OOOF 7ME LA90F COOE,FOR THE PE!iFORMANCE U . OF THE WORK FOH WHICH THIS PERMI7IS ISSUED. W � - ' W � I HAyE AND WILL M4INTAIN W JRKERS'COMPFNSR110N INSURANCE.AS RE�UIRED BY SFCTION � Q �]COOF TM��qgOli WCE,F!Jq THE PERFORMANCE OF THE WOFlK FOR WH�GH THIS PERMIT IS 9�5^�.' +� (- '�� n _ ISSUEG.MYWORKI?RS'(10MPIEN'S�A'T'KKJwIN�S.U.ftAINCECAHRIERAN�POU/CY`NU/M�OERARF: CONSTRUCTION.ver"�Yd �� L�%u j CApRIER�-J-J.L�4�-�1JGf�'l�! I i�,�1.../�'` _._.___ P�N REVIF�,�Y.a . ,. �a�!�{ �i �1 0 raicrrvuMsep I i /] � � B k � 'i.J�C'-�"��L'�'rb�'��a�ic� -�n-�-i- - -- ELECTRIC�, 4p . , �. �;;ry*y/ - • . Q �i:_�11_.�...�� ,...7 . ... . ,_,�x 3 —_— � (1HLSSEC7IUNNEHIKITBEOOMPLETE�OFTNEPFPANTISFOfipJEH.N(7REDDq1NiS(EiaD)ORLESS). PLUMBING W —_ '_— Z �CENTIFY TMAT IN 171E PERFORMANGE UF TNE WORI(FOfl WHICM iH15 PEHMIT IS ISSUED,I MECHANICA� (} SHNLL NOT EMPL010.NY PERSON W ANY MANNER SQ AS TO BECAME SUBJECTTO TNE �-�� — (n wORKERS'COMVFNSATION LAWS OF CALIFORNI ANDAGHEE THAT IF I SHOULD BE�OME INSPECTION FEE � SU&IECTTOTHENIOpKERS'COMPENSATIONP �VISIO f ION3�o00FTHELABOR \ � CCOE.ISHALLFOF;THWITHCOMPLYWI7HT EPRO ISSUANCE __ ;.J�S �! 1 � ��/� p DATE:, r! __ qPPLICANT. �yJ__. SMIP W1 --- —'— J WAfiNINGFAILURETOSECUREWORKERS OMPENSATIONCAVERAGEISUNLAWFUI,ANDSHALLBE ENERGYP/C J � SUBJECTANEMPLDVEHTOCRIMINALPENALTIESANDCIVI�FINESUPTOONEHUNDREDTHOUSAN� ENERGYPERMIT DOIURS(S1o0.000).IN AUDITION TD THE COST OF COMPENSATION,DAMAGES AS PROYI�E�FOR IN J SECTION 3]ae OF iHF LAP(]R CODE,INTEREST,AND ATTORNEY'S FEES. W __ RETENTION FEE: O CONSTRUCTION LENDING AGENCY PRE-ALT FEE: � 1 HEHEBV AFFIq1A UNDEFl PENALTV OF PERJURv THAT THERE IS A CANSTRUCTIpN IENDING AGENCY FOR THE PERFORMANCE OFTHE WORK FOR WHICH THIS PERMIT IS ISSUED(SEC.309].qV C.i. Z W � lENOER'SNAME___ ��-�— F= LENOFR'S ADDRE55__ � w I CERtIFY THAT I MAVE READ THIS APPLICATION AND STATE THAT iHEABOVE INFORMATION IS CORRECT. TOTAL FE ES �� d I AGREE TO CAMPLV WITH ILLL CITV AN�COUNTV ORDINANCES AND STATE L4W5 RELATNG TO BUIL�ING �, CONSTRUCTION,AND HEFE:BV AUTFIORIZE REPRESENTATNES OF THIS COUNTV TO ENTEP UPON THE Z AOOVE-A7ENTIONED PROPERTY FOR INS7ECTION PURPOSFS. COMMENTS � � � �1� � m VERMITTEE E(PRI )/ O M Q � �� l � _ � SIG U OF P MI EE � DATE � RECPT.NO.�._ PAID BY _VALIDATION WHITE—Depertment Copy,YELLOW-finance CoVY.PINK—Assessor Copy,GOLDENROD--File Copy,GREEN—Applicant's Copy �,��_�a,�� *,.�z��r�``��" �.�w�""� ��:�rv��,��'� ��s'^t�,� ,. „�r�� .�� , � ., , ' "t � �€,�r . � d' � � � � �^� � p � � � a ,� � . la � � � ; � � _ � :� �t 3 °�; + _, _ ,,, . � �— e ___ �� _._ W , .. _ __ _ _ — _ '` �.` � . _.� _. _ _ _ � ,.. ,, ,�..._, ; _ — — , — , , __ _. , _... __ . _ 1 F;F't�" _ _ . __ > � : � . :- a- ._ _. __ _ . . _ _ _. . _ . _ ,. __ ., q _ . _ __� _ __ �-�� — � _ �_.,. _ _� . .,.. _ . _ _ u,,. �� , - _ __ __ __ � �� , ;� . _ ;� . �� _ _. _ �.. _ _... __ __ _ .. a'z . �.�,�: , , � ,,. . .:.�°,n,�, — _ � _ _ _ _. _ ._ __ __ _ _ __ _ _+}� . _ ��+rr� _._ _ __.. --- . ; _ _ �t1ct-�1�l4L.. i1.; �'"'Q�c,'4 2 —twU( . __ _ � � �„ a� _ e,� � „ �_�.� „��_ �k.�*�, a:��'��"�� , 1.-.�C��Ot R�%�i'F.�E.zt �'a��'� L<,.l�k�. ..r:.� __ . _ __ _ _ _ __ __ _. _ _ _ _ __ _ _ __ _ _ _ _ _ _ _ . _ _ _ _ _ __ _ , ��Y �� ;. � ;�� .�� , ,'��°�' � u» - - _ _ _ _ � LL � F � ,� � �� _ _ _ _ � I - + ^� i5 ri f i �2 �"5�. �°.� d��'`��.��a � ° — -. ._. .. .. .. _.. _. .. ... .. . ¢ ��' s��`� �^w��.�,� � �t� _ . .. � �. � � �4 ;.�a ,�,� � �e�� . .. . .. . _ ._. ... . ... ... . .. . . . �� '��`�,..�t �q4��f,c+��1�»g �' _.. .. ... � �, �' �9,'�.�" #�"+�i�'� �fi,. `�� 8"�rr�r'<a�es .�wa�-, �� ,� -. _ . ._ ... .._. ... ... . ... _. _... ... . .... . .. ,�k�� .�a�9�f�,.•�.,+r_�.�^�,s+s`x'�'�„�.,.. �.. __.__ . __� ..__... . ._._ ._..... . _...... ... .. . ._... CITY OF DIAMOND BAR DEPARTMENT OF COMMUNITY&DEVELOPMENT SERVICES 21660 E.Copley Drive Suite 190 (909)860-3195 Fax(909)861-3117 BUILDING PERMIT APPLICATION PRESS FIRMLY JOBSITE/� APPLICATION PERMIT P/C ADDRESS 60_IATEL-;^L;f_�ENNeO DATE N UMBER* APN LOT TRACT ISSUE 1 C1 TYPE OCC 1 It,I DATE CONST GROUP OWNER, T2A'-(M . L C�c&CC ZONING SETBACKS ADDRESS;i 1>AR K-ZA � ; iv# (nUC3 CITY L1 z ZIPgZ� 14 TEL. I FRONT RW^ APPLICANT_TEL. _ REAR^ SIDE/SIDE STREET RW CONTRACTOR � '� LTE SIDE � �Tt( L � 1 ADDRESSI IC7?Urs-NIL. IZ CITY A-sA ZIP 91 TELL°iCV316°"�/Z PROPOSED USE ARCH/ENG/ DESIGNER J7AGE ADDRESS 72yZ M f��j�r I L56- N0. DWEL. N0. N0. CITY I-I OI ZIP S TELL UNITS STORIES BEDROOMS 0 DESCRIPTION SQ. FT. FACTOR PSF ADJ.AREAIVALUATION WNER-BUILDER DECLARATION SFR/ADD/REM Gara I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM EXEMPT FROM THE CONTRACTORS LI- e/Car ort CENSE LAW FORTHE FOLLOWING REASON(SEC. 7031.5 BUSINESS AND PROFESSIONS CODE:ANY CITY OR (n 9 p COUNTYWHICH REGUIRESAPERMRTO CONSTRUCT,ALTER.IMPROVE,DEMOLISH.OR REPAIR ANY STRUC- TORE IL Patio/Deck PRIOR TO T I LLI S ISSUANCE.ALSO REQUIRES THE APPLICANT FOR SUCH PERMIT TO FILE A SIGNED STATEMENT THAT HE OR SHE IS LICENSED PURSUANT TO THE PROVISIONS OF THE CON TRACTORS LI- CENSE LAW CHAPTER 9 LL T COMMENCIN � � G WI (5 Pool/Spa H SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PRO- FESSIONS CODE)OR THAT HE OR SHE IS EXEMPT THEREFROM AND THE BASIS FOR THE ALLEGED EXEMP- TION.ANY VIOLATION OF SECTION 7031.5 BY ANY APPLICANT FOR A PERMIT SUBJECTS THE APPLICANT TO Z Re-Roof A CML PENALTY OF NOT MORE THAN FIVE HUNDRED DOLLARS($500).): 0 1,AS OWNER OF THE PROPERTY. OR MY EMPLOYEES WITH WAGES AS THEIR SOLE COMPENSATION. Commercial WILL DO THE WORK,AND THE STRUCTURE IS NOT INTENDED OR OFFERED FOR SALE(SEC. 7061,BUSI- NESSAND PROFESSIONS CODE:THE CONTRACTORS LICENSE LAW DOES NOT APPLY TO AN OWNER OF PROPERTY WHO BUILDS OR IMPROVES THEREON.AND WHO DOES SUCH WORK HIMSELF OR HERSELF OR co THROUGH HIS OR HER OWN EMPLOYEES. PROVIDED THAT SUCH IMPROVEMENTS ARE NOT INTENDED OR OFFERED FOR SALE IF. HOWEVER THE BUILDING OR IMPROVEMENT IS SOLD WITHIN ONE YEAR OF COMPLE- TION.THE OWNER-BUILDER WILL HAVE THE BURDEN OF PROVING THAT HE OR SHE DID NOT BUILD OR IMPROVE FOR THE PURPOSE OF SALE). ^ I.AS OWNER OF THE PROPERTY,AM EXCLUSIVELY CONTRACTlNG WITH LICENSED CONTRACTORS TO CONSTRUCT THE PROJECT(SEC. 7011, BUSINESS AND PROFESSIONS CODE:THE CONTRACTORS LI- Valuation ADJ AREA CENSE LAW DOES NOT APPLY TO AN OWNER OF A PROPERTY WHO BUILDS OR IMPROVES THEREON,AND WHO CONTRACTS FOR SUCH PROJECTS WITHACONTRACTOR(S)LICENSED PURSUANT TO THE CONTRAC- QUANTITY DESCRIPTION TORS LICENSE LAW.). FEE ^ I AM EXEMPT UNDER SEC. B. E P.C. FOR THIS REASON U I YLTGFeE�� DATE 2 w OWNER U ' 'ONE C,) T LICENSED CONTRACTORS DECLARATION Lu , N UL1 J,TCrI_ I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT I AM LICENSED UNDER PROVISIONS OF CHAPTER c 9(COMMENCING WITH SECTION 7000)OF DIVISION 3 OF THE BUSINESS AND PROFESSIONS CODE,AND MY LICENSE IS IN FUL Z R F L 0 CE AND EFFECT.,/- �--75 GO 79 }t4 LICENSE CLASS LIC. N0. 5CX -J �S d DATE =�j i I CONTRACTOR�'I( LTFtZ�L�(�'I C Y I WORKERS Q COMPENSATION DECLARATION I HEREBY AFFIRM UNDER PENALTY OF PERJURY ONE OF THE FOLLOWING DECLARATIONS: I HAVE AND WILL MAINTAIN A CERTIFICATE OF CONSENT TO SELF-INSURE FOR WORKERS' COMPENSATION,AS PROVIDED BY SECTION 3700 OF THE LABOR CODE. FOR THE PERFORMANCE U OF THE WORK FOR WHICH THIS PERMIT IS ISSUED. I HAVE AND WILL MAINTAIN WORKERS'COMPENSAT ION INSURANCE.AS REQUIRED BY SECTION O .Ydpp('p�� 3700 OF THE LABOR CODE, FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS . 0 ISSUED CONSTR MY WORKERS'COMPENSATION INSURANCE CARRIER AND PO ,A IC C N U L TION. Y L UMBER ARE PLAN REVI rt-,a CARRIER D.LU . f,4PFk1,1 t rYii -CA )B 14 POLICY NUMBER I1/] . �T-' ELECTRIC k (THIS SECTION NEED NOT BE OOMPLETEDOF THE PERMIT IS FOR ONE HUNDRED DOLLARS($100)OR LESS). PLUMBING I CERTIFY THAT IN THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED.I MECHANICAL SHALL NOT EMPLOY ANY PERSON IN ANY MANNER SO AS TO BECOME SUBJECT TO THE - WORKERS'COMPENSATION LAWS OF CALIFORNI AND AGREE THAT IF I SHOULD BECOME INSPECTION FEE SUBJECT TO THE WORKERS'COMPENSATION P VISIO F ION 3700 OF THE LABOR CODE.I SHALL FORTHWITH COMPLY WITH TH E PRO ISSUANCE S LJ�I DATE: -•Y)_APPLICANT. SMIP WARNING: FAILURE TO SECURE WORKERS OMPENSATION COVERAGE IS UNLAWFUL.AND SHALL BE ENERGY P/C SUBJECT AN EMPLOYER TO CRIMINAL PENALTIES AND CIVIL FINES UP TO ONE HUNDRED THOUSAND ENERGY PERMIT DOLLARS($100,000),IN ADDITION TO THE COST OF COMPENSATION, DAMAGES AS PROVIDED FOR IN SECTION 3708 OF THE LABOR CODE,INTEREST,AND ATTORNEYS FEES. RETENTION FEE: CONSTRUCTION LENDING AGENCY PRE-ALT FEE: I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THERE IS A CONSTRUCTION LENDING AGENCY FOR THE PERFORMANCE OF THE WORK FOR WHICH THIS PERMIT IS ISSUED S C � . 3097.CIV C.). E LENDER'S NAME LENDER'S ADDRESS I CERTIFY THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE INFORMATION IS CORRECT. TOTAL FEES 1 f a>� I AGREE TO COMPLY WITH ALL CITY AND COUNTY ORDINANCES AND STATE LAWS RELATING TO BUILDING , CONSTRUCTION,AND HEREBY AUTHORIZE REPRESENTATIVES OF THIS COUNTY TO ENTER UPON THE ABOVE-MENTIONED PROPERTY FOR INSPECTION PURPOSES. COMMENTS PERMITTEE E(PRI )/0 M SIG U OF P MI EE DATE RECPT. N0. PAID BY VALIDATION WHITE-Department Copy,YELLOW-Finance Copy. PINK-Assessor Copy,GOLDENROD-File Copy,GREEN-Applicant's Copy I-,ORot_R� i__�Y. -,_t.�t:,.